RU2789580C1 - Method for manufacturing an individual maxillofacial implant - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely surgical dentistry, maxillofacial surgery and can be used in clinical practice in the design and manufacture of individual implants. A method is proposed, which consists in creating, according to computed tomography, a virtual 3D computer model of the patient’s jaw, containing base points for positioning it relative to existing antagonist teeth, or digital prototypes of teeth or mirroring models of the patient’s existing teeth from the opposite side of the jaw, or scanning prototype teeth models made of various materials for their modeling. The base points are the points at which computer tomography data and 3D scans of dentition or toothless jaws are compared in a software virtual environment. Subsequently, the creation of a computer model of an individual maxillofacial implant based on the base points. The reconstructed defect surfaces are transformed into the basic segment of the implant, which includes up to 4 orthopedic support elements for dental or dentofacial prostheses. The base segment of the implant may not have orthopedic support elements if the implant is used only for directed bone regeneration of the alveolar bone, and may be solid or mesh, equipped with attachment elements to the patient’s jaw, depending on the number of orthopedic support elements.

EFFECT: method makes it possible to create individual maxillofacial implants for patients with severe forms of atrophy of the jaw bones, which developed as a result of tooth loss, inflammatory processes, trauma, congenital pathology, as well as after surgical treatment of oncological diseases.

7 cl, 16 dwg

Description

Technical field

The invention relates to medicine, namely to surgical dentistry, maxillofacial surgery, and can be used in clinical practice in the design and manufacture of individual implants.

State of the art

A known method for manufacturing a volumetric membrane for osteoplasty (patent for invention RU 2669860 C1, IPC classes G16H 30/20, A61F 2/30, publ. 10/16/2018), including the creation of a digital model of the membrane during digital processing of a volumetric digital model of a bone tissue area, the creation base, made in accordance with the digital model of the membrane, with the possibility of changing the shape of the base, formed by an array of elements made in the form of faceted rods tightly fitted to each other along the edges, by shifting the elements of the array relative to each other, the manufacture of the membrane by layer-by-layer sintering of a polymer material, which differs the use of polymeric materials for the manufacture of membranes, which can be subjected to deformation under the action of various forces.

In the patent for the invention of RU 2717212 C1 (MPC class A61b 17/00, publ. 03/18/2018), the method of production of an individual mesh frame to correct the jaw defect, characterized by the fact that the patient is conducted by the study of the mouth, the result of the study is combined with a computer tomogram for separation for separation soft tissues from bone structures. The necessary volume of bone tissue is virtually increased to eliminate the defect, the jaw contours are restored with the subsequent modeling of the individual frame with the release of the future placement of the fixing screws, as well as the holes for making bone material inside the frame and, taking into account the anatomical features of the patient's skull, according to the results of the modeling, perform an individual frame made of material used for osteosynthesis. The design of the frame does not provide for the presence of suprastructures for the installation of orthopedic restorations.

There is a utility model patent RU 162614 U1 (IPC class A61C 8/00, publ. 06/20/2016), the essence of which is the use of an endosseous-subperiosteal implant containing an intraosseous part and an extraosseous part, while the extraosseous part includes a subperiosteal plate equipped with a hole for its installation, the intraosseous part contains a threaded rod, on which annular rubber-metal bushings are located, while the subperiosteal plate is provided with a metal-rubber substrate. The threaded rod of the intraosseous part contains two cylindrical threaded sections, while the upper cylindrical section is made of a larger diameter than the lower one. The thread in the lower part of the upper cylindrical section is made with a pitch smaller than the thread in its upper part, vertically oriented decompression grooves are made on the surface of the upper threaded section. The threaded rod is equipped with a drill tip, the subperiosteal plate is provided with a metal-rubber substrate that repeats the shape of the plate; annular bushings are made of metal rubber with a porosity of 70-80%; the subperiosteal plate is provided with additional holes for its fixation; the connection of the intraosseous and extraosseous parts is made collapsible. The design of the implant does not imply simultaneous bone grafting during the implantation operation.

The invention RU 2748200 C1 (class IPC A61C 13/107, publ. 05/20/2021) is known, which is a device for temporary prosthetics for the period of directed bone regeneration of the jaw, including a titanium perforated plate that repeats the geometry of the jaw area. At the same time, the plate has a bulge in the area where the bone -schedule will be distributed, and holes are made in four opposite ends of the plate for its screw fixation to the bone of the jaw. The device additionally includes at least one cylinder with circular retention elements for the subsequent fixation of the temporary crowns, and one cylinder is made on the plate in the area, the corresponding area of implantation, the cylinder is made at a bloom with a plate. The difference between the invention is to use it as a temporary design.

The disadvantages of the known technical solutions is the multi-stage and long time required for the individualization of the implant, as well as insufficient accuracy.

Disclosure of invention

The proposed method can be used both as a scaffold for guided bone regeneration and as a platform for dental implants. It is possible to perform an operation with the installation of an implant with simultaneous guided bone regeneration. One-time fixation of orthopedic restorations after implant placement.

The technical objective of the invention is the digital design of individual maxillofacial implants and their manufacture using additive technologies, as well as the introduction into clinical practice of an individual maxillofacial implant to replace defects in the bone tissue of the jaws and dentition.

The technical result is to increase the accuracy and quality of the manufacture of implants, which leads to a decrease in the number and severity of complications in the postoperative period. The proposed method also makes it possible to take into account the individual characteristics of the anatomy of the defects of each patient, to increase the efficiency and speed of the doctor's work.

The specified technical result is achieved by the fact that the method of manufacturing an individual maxillofacial implant includes the creation of a virtual computer 3D model of the patient's jaw, based on computed tomography data, containing base points for positioning it relative to existing antagonist teeth, or digital prototypes of teeth, followed by the creation of a computer model an individual maxillofacial implant based on the base points of a virtual model of existing antagonist teeth, or digital prototypes of teeth and containing reconstructed defect surfaces and elements of implant attachment to the patient's jaw, which consists of a base segment and is manufactured using additive technologies.

Digital prototypes of teeth can be made using virtual or dental modeling.

Also, digital models of teeth can be obtained from a library of digital tooth prototypes or by mirroring models of the patient's existing teeth on the opposite side of the jaw or by scanning a model of tooth prototypes made of wax, plastic, gypsum.

Selective laser or electron-beam fusion of powders from structural materials of medical design can be used as additive technologies.

In the manufacture of an implant, titanium alloy VT6 can be used as a structural material.

The base segment can additionally include up to four orthopedic support elements for dental or dentoalveolar prostheses, depending on the number of missing teeth and the shape of the jaw defect.

The base segment can be made solid or mesh.

Brief description of the drawings

In FIG. 1 shows a virtual computer 3D model of a section of the lower jaw of the patient with partial loss of teeth.

In FIG. 2 shows a 3D model of the lower jaw area with an orthopedic structure with partial loss of teeth.

In FIG. 3 shows a model of an individual maxillofacial implant without orthopedic supports with partial loss of teeth.

In FIG. 4 shows a model of an individual maxillofacial implant with orthopedic supports for partial loss of teeth.

In FIG. 5 shows a virtual 3D computer model of the lower jaw of a patient with complete loss of teeth.

In FIG. 6 shows a 3D model of the mandible with an orthopedic structure with complete loss of teeth.

In FIG. 7 shows a model of an individual maxillofacial implant without orthopedic supports in case of complete loss of teeth.

In FIG. 8 shows a model of an individual implant with orthopedic supports in case of complete loss of teeth.

In FIG. 9-16 are images illustrating an example of the practical implementation of the claimed method in a clinical situation.

In FIG. 9 shows the type and size of the bone defect.

In FIG. 10-11 shows the creation of a 3D model of a titanium membrane.

In FIG. 12 shows a section of the mucous membrane.

In FIG. 13 shows the exfoliation of the mucoperiosteal flap.

In FIG. 14 shows the filling of the membrane with bone material.

In FIG. 15 shows the fixation of the membrane.

In FIG. 16 shows the end of the operation.

The following designations are accepted on the figures: 1 - 3D model of the jaw, 2 - mental hole, 3 - base segment of the implant, 4 - fixing elements, 5 - orthopedic support elements.

Implementation of the invention

The method consists in creating a virtual computer 3D model of the patient’s jaw (Fig. 1, 5), then the VMF (virtual model of the jaw), according to computed tomography. The model of the Navy contains basic points for positioning it relative to existing antagonist teeth, or digital prototypes of teeth made using virtual or clinical-subechnical modeling. Digital models of teeth from the library of digital dental prototypes or mirror display of the patients of the patient’s tooths are used on the opposite side of the jaw (Fig. 2, 6), or the models of dental prototypes made of wax, plastic, gypsum and other materials for modeling are scanned.

Base points are points by which, in a software virtual environment, data from computed tomography and a 3D scan of the dentition or edentulous jaws are compared for subsequent accurate modeling of an individual maxillofacial implant. regarding the teeth of antagonists. The number of such points corresponds to the number of remaining teeth in the patient, the points are placed along the tops of the tubercles of the molars, premolars and canines and / or in the middle of the cutting surface of the incisors. In the absence of teeth, points are placed on the radiological template, with which the patient's computed tomography is performed - also along the tubercles of artificial teeth or additional radiopaque marks (Fig. 6).

In the state of a fixed occlusion, the HCM is positioned according to the antagonist teeth, taking into account the data of the central and lateral closure of the jaws, and for an unfixed occlusion, a computer model is created taking into account the data of the central and lateral ratio of the jaws.

On the basis of the patient's created TMF, a computer model of an individual maxillofacial implant is created using the base points of the TMF of the existing antagonist teeth, or digital prototypes of the teeth and containing the reconstructed defect surfaces and implant attachment elements.

The computer 3D model of the maxillofacial implant consists of a base segment (Fig. 3, 7) and up to four orthopedic support elements (hereinafter referred to as OEE) (see Fig. 4, 8), for dental or dentoalveolar prostheses, depending on the number of lost teeth and jaw defects. The base segment may not have orthopedic support elements if the implant is used only for guided bone regeneration of the alveolar bone (Fig. 3, 7).

The base segment can be solid or mesh, equipped with fastening elements to the patient's jaw. There must be at least four fasteners for one OOE, and at least two for each subsequent one (Fig. 3, 4, 7, 8). If necessary, protective or bioresorbable coatings are applied to the base segment.

The base segment of the implant on the side of the jaw bone provides a tight fit of the implant to the jaw, and in the presence of bone defects it can have a space between the bone and the implant in order to fill this space with materials for guided bone regeneration.

Individual maxillofacial implants are made on additive installations, for example, selective laser or electron beam fusion of powders from structural materials of medical design, for example, titanium alloy VT6.

Orthopedic support elements of a custom maxillofacial implant align with the opposing teeth and provide immediate fixation of temporary or permanent dentures, either with screws or with temporary or permanent cement formulations.

An example of implementation in a clinical situation

The patient with complaints about the absence of the front teeth of the lower jaw and the difficulty biting of food turned to the clinic. An examination of the oral cavity and radiological diagnostics were examined, during which the ICD was diagnosed: K08. 1 - loss of teeth due to an accident, removal or local periodontal disease, K08. 2 - atrophy of the edentulous alveolar margin (Fig. 9). The patient was offered a treatment option with a directed bone regeneration to restore the height and width of the alveolar ridge using individual titanium maxillofacial implant with further dental implantation. Based on the computed tomography of the patient's lower jaw area, a 3D implant model was created with perforations and fixing elements for titanium miniscrews (Fig. 10, 11). Next, an individual implant for guided bone regeneration was fabricated using an additive setup. Protocol of the operation: under infiltration and conduction anesthesia, an incision was made along the top of the alveolar ridge and exfoliation of the mucoperiosteal flap (Fig. 12, 13). Bone material was applied and the implant was fixed to the bone using titanium miniscrews (Figs. 14, 15). Reduction of the edges of the surgical wound and suturing (Fig. 16).

This method allows you to design and manufacture individual maxillofacial implants for patients with severe forms of atrophy of the jaw bones that have developed as a result of tooth loss, inflammatory processes, trauma, congenital pathology, as well as after surgical treatment of oncological diseases.

The creation of a high-precision computer model, as well as the use of additive technologies in the manufacture of an implant, allows reconstructing defects with maximum accuracy and reducing the risk of complications.

A comparative analysis of the claimed method for manufacturing an individual maxillofacial implant shows that the totality of its essential features is unknown from the prior art and, therefore, corresponds to the patentability condition "Novelty".

In the level of technology, there were no signs that coincide with the distinctive features of the declared method and affect the achievement of the declared technical result, therefore the declared invention corresponds to the condition of the “inventive level” patent capacity.

The information provided confirms the possibility of applying the claimed technical solution in the design and manufacture of individual maxillofacial implants for patients with severe forms of jaw bone atrophy, and therefore complies with the patentability condition "Industrial applicability".

Claims (7)

1. A method of manufacturing an individual maxillofacial implant, including the creation of a patient’s jaw of the patient, containing basic points, the number of which corresponds to the number of remaining teeth in the patient, and the basic points are placed according to the vertices of prayers, premolar and fangs and fangs and fangs and fangs and fangs and fangs and fangs. / or in the middle of the cutting surface of the incisors, and in the absence of teeth, the points are placed on the radiological template, with which the patient's computed tomography is performed - also along the tubercles of artificial teeth or additional radiopaque marks, while the base points serve to position it relative to the existing antagonist teeth, or digital prototypes of teeth and containing reconstructed surfaces of the defect and elements of fastening the implant to the patient's jaw, which consists of a base segment and is manufactured using additive technologies. 2. The method according to claim 1, characterized in that the digital prototypes of the teeth are made using virtual or clinical dental modeling. 3. The method according to claim 1, characterized in that digital tooth models are obtained from a library of digital tooth prototypes or by mirroring models of the patient's existing teeth on the opposite side of the jaw or by scanning a model of tooth prototypes made of wax, plastic, plaster. 4. The method according to p. 1, characterized in that selective laser or electron beam fusion of powders from structural materials of medical design is used as additive technologies. 5. The method according to p. 4, characterized in that in the manufacture of the implant, titanium alloy VT6 is used as a structural material. 6. The method according to claim 1, characterized in that the base segment additionally includes up to four orthopedic support elements for dental or dentoalveolar prostheses, depending on the number of lost teeth and the shape of the jaw defect. 7. The method according to p. 1, characterized in that the base segment is made solid or mesh.

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